Claims Analyst jobs in Worcester, MA

Claims Analyst analyzes and reviews insurance claims for accuracy, completeness, and eligibility. Reviews claims for eligibility to be reimbursed. Being a Claims Analyst maintains updated records and prepares required documentation. Assists in controlling the cost of processing claims. Additionally, Claims Analyst contacts policyholders about claims and may provide information regarding the amount of benefits. May require a bachelor's degree or its equivalent. Typically reports to a supervisor or manager. The Claims Analyst gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Claims Analyst typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)

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Stop Loss Claims Analyst
  • Berkley
  • Marlborough, MA OTHER
  • Company Details

     

    Berkley Accident and Health is a risk management company that designs innovative solutions to address the unique challenges of each client. With our entrepreneurial culture and a strong emphasis on analytics, we can help employers better manage their risk. We offer a broad range of products, including employer stop loss, benefit captives, provider stop loss, HMO reinsurance, and specialty accident. The key to Berkley’s success is our nimble approach to risk – our ability to quickly understand, think through, and devise a plan that addresses each client’s challenges, coupled with the strong backing of a Fortune 500 company. Our parent company, W. R. Berkley Corporation, is one of the largest and best managed property/casualty insurers in the United States.

     

    The company is an equal employment opportunity employer.

     

    Responsibilities

    We have an opportunity for a Stop Loss Claims Analyst to join our Berkley Accident and Health team! You will perform quality review and evaluation of all claim submissions received and logged into our claims system to determine whether the amount requested is eligible for reimbursement. 

     

    We have a welcoming culture valuing our employees – we trademarked the phrase Everything Counts, Everyone Matters® to describe the Berkley commitment to our people and how we do business. We believe that every person in the organization is important and every accomplishment makes a difference in our results. Come join us!   

     

    This role can be based in any of our offices in: Marlborough, MA, Hamilton Square, NJ; West Hartford, CT; or Kulpsville, PA

     

    Key functions include but are not limited to:

    • Process an average of 5 to 7 claims per day
    • Maintain a processing accuracy of 99% or better
    • Determine, on a timely basis, the eligibility of assigned claim by applying the appropriate contractual provisions to the medical facts and specifications of the claim
    • Review and adjudicate claims within approved authority limits
    • Maintain assigned claim block and assist other team members while meeting departmental guidelines
    • Document rationale of claim decisions based on review of the contractual provisions, plan specifications and the analysis of medical records, etc.
    • Elevate issues to next level of supervision, as appropriate
    • Other duties as assigned

    Qualifications

    • 3 years reinsurance claims experience is required
    • Prior experience handling first dollar payer insurance (medical healthcare claims)
    • Experience with medical billing practices, CPT codes, revenue codes, and/or universal billing
    • Ability to use mathematics to adjudicate claims
    • Detail oriented with a high degree of accuracy and ability to multitask
    • Ability to accept changing priorities with a minimum of disruption
    • Strong problem solving, decision-making, reporting and analytical skills
    • Must possess good judgment and work effectively with internal business areas, peers and co-workers
    • Ability to work independently, prioritize, organize and assign own work to meet deadlines 
    • Demonstrated proficiency in Microsoft Office software, including Microsoft Word and Excel

    Additional Company Details

    We do not accept any unsolicited resumes from external recruiting firms. The company offers a competitive compensation plan and robust benefits package for full time regular employees. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.
  • 1 Month Ago

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Medical Claims Representative
  • Robert Half
  • Fort Wayne, IN PER_DIEM
  • Needing a medical claims follow-up individual. Responsibilities include: * Must have a medical background* Claims follow-up experience* Follow-up on insurance* Patient claims paid* Customer service* M...
  • Just Posted

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Auto Damage Claims Adjuster
  • Concord Group Insurance
  • Westborough, MA FULL_TIME
  • Auto Damage Claims Adjusters handle auto claims through the life-cycle including but not limited to: investigation, evaluation and claim resolution. The purpose of this position is to provide service ...
  • 10 Days Ago

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Bodily Injury Claims Representative
  • Concord Group Insurance
  • Westborough, MA FULL_TIME
  • This Branch Claims Representative handles bodily injury and general liability claims through their life-cycle including - but not limited to - investigation, evaluation and claim resolution. The purpo...
  • 10 Days Ago

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Associate Claims Adjuster - Trainee
  • Trainee - Concord Group Insurance
  • Westborough, MA FULL_TIME
  • Claims Adjuster Trainees handle entry-level insurance claims under close supervision through the life-cycle of a claim including but not limited to: investigation, evaluation and claim resolution. The...
  • 8 Days Ago

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Insurance Branch Claims Representative
  • Concord Group Insurance
  • Westborough, MA FULL_TIME
  • The Branch Claims Representative II investigates, evaluates and determines the appropriate disposition of all types of claims, with varied levels of complexity, arising out of the Company’s business. ...
  • 8 Days Ago

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0 Claims Analyst jobs found in Worcester, MA area

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System Analyst - Healthcare/Claims
  • Planet Technology
  • Smithfield, RI
  • Duration - 9 months Location - Smithfield, RI - Mon-Thu onsite - Fri remote Configuration Analyst - Smithfield, RI This ...
  • 3/26/2024 12:00:00 AM

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Senior Data Analyst - Risk Adjustment
  • Point32Health
  • Canton, MA
  • Under the supervision of the Manager, Data and Reporting, this individual will be responsible for supporting critical da...
  • 3/26/2024 12:00:00 AM

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Pharmacy Claims Analyst- Hybrid (Quincy, MA)
  • University of Massachusetts Medical School
  • Quincy, MA
  • Overview POSITION SUMMARY: Under the direction of the Director of Pharmacy Technology and Informatics or designee, the P...
  • 3/26/2024 12:00:00 AM

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Customer Service Associate, Topo (Remote)
  • Designer Brands
  • Framingham, MA
  • Brand: Camuto Group Req #: 144201 Location Name: Topo Athletic Department: Topo General Summary: This position is part o...
  • 3/26/2024 12:00:00 AM

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IT Business Analyst (REMOTE)
  • Careerbuilder
  • Worcester, MA
  • For more than 170 years, The Hanover has been committed to delivering on our promises and being there when it matters th...
  • 3/25/2024 12:00:00 AM

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Senior Manager - Architecture (Remote)
  • Intact Insurance
  • Canton, MA
  • Job Description We currently have an opportunity for a Senior Manager, Architectural Engineering to join our Corporate I...
  • 3/25/2024 12:00:00 AM

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Healthcare Business Analyst
  • KYYBA
  • Quincy, MA
  • Job Description Job Description Must be local to MA and should be open for onsite hybrid from day one Qualifications:  ...
  • 3/25/2024 12:00:00 AM

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Principal SAP Functional Analyst, Warranty/Service Management
  • Symbotic
  • Wilmington, MA
  • Who we are With its A.I.-powered robotic technology platform, Symbotic is changing the way consumer goods move through t...
  • 1/26/2024 12:00:00 AM

Worcester has a total area of 38.6 square miles (100 km2), 37.6 square miles (97 km2) of land and 1.0 square mile (2.6 km2) (roughly 2.59%) of water. Worcester is bordered by the towns of Auburn, Grafton, Holden, Leicester, Millbury, Paxton, Shrewsbury, and West Boylston. Worcester is known as the Heart of the Commonwealth, because of its proximity to the center of Massachusetts. The city is about 40 miles (64 km) west of Boston, 50 miles (80 km) east of Springfield, and 38 miles (61 km) northwest of Providence, Rhode Island. The Blackstone River forms in the center of Worcester by the conflue...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Analyst jobs
$40,610 to $52,077
Worcester, Massachusetts area prices
were up 1.6% from a year ago

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